Cardiopulmonary compromise after use of topical and submucosal alpha-agonists: possible added complication by the use of beta-blocker therapy

Otolaryngol Head Neck Surg. 1997 Jul;117(1):56-61. doi: 10.1016/S0194-59989770207-9.

Abstract

We report the specifics of 12 cases of severe hypertension after the intraoperative use of topical phenylephrine, submucosal epinephrine, or both. Ten of these 12 patients also developed severe pulmonary edema. Seven of the twelve were treated with beta blockers; 3 of whom suffered cardiac arrest. We propose a common mechanism: the vasoconstrictors caused systemic hypertension, increased left ventricular afterload, decreased left ventricular compliance, and decreased cardiac output. In those patients treated with beta blockers, decreased contractility and inability to increase heart rate further compromised cardiopulmonary function.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Intranasal
  • Adrenergic alpha-Agonists / adverse effects*
  • Adrenergic beta-Antagonists / adverse effects*
  • Child
  • Epinephrine / adverse effects
  • Female
  • Heart Arrest / chemically induced
  • Humans
  • Hypertension / chemically induced*
  • Hypertension / drug therapy
  • Intraoperative Complications / chemically induced*
  • Intraoperative Complications / drug therapy
  • Intubation, Intratracheal
  • Labetalol / adverse effects
  • Male
  • Phenylephrine / adverse effects
  • Propanolamines / adverse effects
  • Pulmonary Edema / chemically induced

Substances

  • Adrenergic alpha-Agonists
  • Adrenergic beta-Antagonists
  • Propanolamines
  • Phenylephrine
  • esmolol
  • Labetalol
  • Epinephrine